Oral health care will soon be more accessible for young North Carolinians who have been systemically underserved.

On December 13, 2019, the North Carolina Board of Dental Examiners unanimously voted to approve an important rule change that will increase access to quality, affordable oral health care. The change to Occupational Licensing Boards and Commissions Rule 16W will allow dental hygienists to further practice to the full extent of their licensure. The rule change has the potential to increase preventive services such as sealants and fluoride treatments to children, in high-need settings, without a dentist’s prior exam.

“With 74 of 100 North Carolina counties deemed as dental health provider shortage areas (HPSA), the state has a crisis of access to oral health services, primarily affecting our most vulnerable populations. This rule change means that we will have a real opportunity to increase access for those who are chronically underserved and ultimately prevent detrimental oral health outcomes later in life.”

—Dr. Zachary Brian, director of the North Carolina Oral Health Collaborative (NCOHC), a program of the Foundation for Health Leadership & Innovation

Before it goes into effect, this rule change, co-sponsored by the FHLI’s NCOHC and the North Carolina Dental Society (NCDS), must receive final approval from the Rules Review Commission. Approval is currently anticipated in mid-January 2020.

Here’s what the rule change means and how it could impact oral health care in North Carolina.

A Preventable Oral Health Crisis

Tooth decay is the single most common chronic childhood disease, disproportionately affecting low-income populations. Nationwide, roughly 50 percent of children in low-income families experience tooth decay, and dental disease is responsible for a collective 51 million hours of school missed each year.

Only 16 percent of children ages 6 to 9 have received a sealant on a permanent tooth.

Cost of care is a significant barrier that prevents children and families from accessing oral health care. At one-third the cost of a cavity filling, dental sealants are a low-cost solution that can dramatically reduce the likelihood that an individual will develop a cavity during childhood.

Unfortunately, North Carolina’s requirement that a child have a prior exam from a dentist before a dental hygienist can apply a sealant adds additional cost and delays to the process.

Dental Sealants and Dental Hygienist Licensure

A dental sealant is a thin coating applied to the chewing surfaces of a child’s back teeth. The application of a sealant is a simple and painless procedure that adds an extra layer of protection to the molars, teeth which are most susceptible to decay because of the pits and grooves on their chewing surfaces. A dental sealant protects against 80 percent of cavities for two years, and 50 percent of cavities for up to four years.

In 39 states across the country, dental hygienists can apply dental sealants without a prior exam or direct supervision from a dentist. This procedure is part of a dental hygienist’s education, but in states like North Carolina, hygienists can be hindered due to administrative barriers of the prior examination requirement.

How Will This Rule Change Impact Access to Care?

Without the requirement for a prior exam by a dentist, dental hygienists can offer sealants in alternative settings like schools or after-school clinics rather than at a dentist’s office. School sealant programs, in particular, are a very effective method for reaching children who would otherwise not see a private dentist.

According to the CDC, each tooth sealed saves more than $11 in treatment costs down the road. With just over one million low-income children in North Carolina, expanded access to dental sealants has the potential to prevent costly restorative treatment needs like dental fillings later in life.

What Comes Next?

NCOHC and NCDS have engaged in a new and productive partnership to co-sponsor this rule change, and NCOHC will continue to engage NCDS for productive changes to North Carolina’s oral health care landscape.

Similar to the restrictions on providing sealants and other preventive services, dental hygienists in North Carolina are also hindered in the ability to administer local anesthesia, a clinical skill that is valuable to patient comfort and whole-person care. In fact, North Carolina is one of just six states that prevents dental hygienists from administering anesthesia. NCOHC is currently evaluating this regulation for potential advocacy engagement in the future.